Today I will write about my friend Olive. Olive was a patient at our hospital for about 2 months and 12 years old. When I first met her, she was lying in bed in our pediatric ward. I was told she probably had a congenital heart condition and that her heart was now failing. As an interested pediatrician, I went over to have a listen to her heart. I could see her heart heaving under her ribs and what I heard was a mess of extra heart sounds that made it clear, whatever the cause, things were not good. Her parents eagerly looked at me; a new doctor coming to see their child must be a good thing, right? I awkwardly smiled and walked away. I didn’t have the words in French, English or Swahili to tell them there was nothing we could do.
The next day, Olive started to cough up blood. We tested her for tuberculosis, and she was positive. Maybe all her problems were related to this disease? I can’t perform heart surgery, but I can order tuberculosis meds! And in fact, Olive started to get better. The ulcers on her legs, from the chronic swelling, started to heal a little. She started to eat more and that pained look on her face started to fade (aided also by the addition of morphine with bandage changes). I was really happy! I convinced myself that 6-9 months of quadruple tuberculosis meds would do the trick.
Last week I went for my informal afternoon rounds. I was asked to see Olive, who had refused to eat all day. It turns out, she was on a bit of a hunger strike. With a sassy attitude, typical of all pre-teens, Olive would not eat until we sent her to Goma to have her hair braided. I had to giggle a bit at this scene that could happen anywhere in the world. Olive was a typical 12 year old girl, who had been stuck in bed in a dark pediatric ward for too long…and she wanted OUT!
But then I started to realize, despite her speaking Swahili, that Olive seemed to be acting confused. I got the nutritionist to interpret for me, and we both realized that she was incoherent, talkative, and anxious. I looked at her more closely in the dim light of the ward and realized the whites of her eyes had become dark yellow. Olive was in liver failure, likely a side effect of the tuberculosis meds, and the build up of toxins in her body were affecting her brain. Our only choice was to stop them, and then slowly replace them with a secondary regime that had less effect on the liver.
The problem still remained that Olive was confused and going stir crazy, so I took her outside, into the sun. She absolutely lit up! None of us understood each other officially, but we all knew how great it is to laugh and be in the sun. As the sun started to set on the hospital grounds, I left Olive with the promise to visit her the next day, and with a promise from her that she would start eating.
Olive’s confusion started to improve after a few days, but her breathing got worse. She ended up being transferred to our Intensive Care Unit for closer observation. She slept most of the time. On Friday morning, after chatting with the nurses, Olive closed her eyes and slipped away.
Although I have experienced it many times, death continues to humble me. We have a sense in the West that illness = treatment = cure. But it is too often more complicated than that. In the moment I heard about Olive’s death, I felt the weight of poverty, of inequality, and of insecurity in the mix. But today I choose to remember Olive’s laughter, her strength, the way she held my hand and that she was a 12 year old girl. Death cannot take my memories.